Cisplatin - Uses, Dose, MOA, Brands, Side effects, Warnings

Cisplatin inhibits DNA synthesis via various mechanisms mentioned in the section labeled "Mechanism of action". It is used to treat the following cancers:

Off-Label Uses of cisplatin in Adults include:

  • Squamous cell Anal cancer
  • Metastatic Breast cancer
  • Cervical cancer
  • Recurrent high risk metastatic endometrial carcinoma
  • Esophageal cancer
  • Gastric cancer
  • High risk Gestational trophoblastic neoplasia
  • Locally advanced and metastatic Head and neck cancer
  • Advanced Hepatobiliary cancer
  • Hodgkin lymphoma
  • Malignant pleural mesothelioma
  • Multiple myeloma
  • Relapsed and refractory Non-Hodgkin lymphoma
  • Non-small cell lung cancer
  • Osteosarcoma
  • Metastatic Penile cancer
  • Small cell lung cancer
    • extensive-stage disease
    • limited-stage disease
  • Advanced or metastatic Thymomas
  • Central nervous system tumors
  • Metastatic Melanoma
  • Neuroendocrine tumors
  • Advanced Pancreatic cancer
  • Primary CNS lymphoma
  • Prostate cancer
  • Unknown primary cancers

Cisplatin dose in Adults:

Note:

  • Prior to initiation of cisplatin therapy, the patient should be well hydrated and the urinary output should be adequate. Since cisplatin is highly emetogenic, antiemetics must be administered prior to cisplatin administration.

Off-label use in metastatic squamous cell Anal carcinoma:

Advanced Bladder cancer:

  • 50 to 70 mg/m2 intravenous every 3 to 4 weeks

Off-label use in triple-negative Breast cancer:

  • 75 mg/m2 on day 1 every 3 weeks for 4 cycles.

Off-label use in Cervical cancer:

  • 75 mg/m2 on day 1 every 3 weeks in combination with fluorouracil and radiation for 3 cycles or
  • 70 mg/m2 on day 1 every 3 weeks for 4 cycles in combination with fluorouracil (cycles 1 and 2 given concurrently with radiation) or
  • 50 mg/m2 on day 1 every 4 weeks in combination with radiation and fluorouracil for 2 cycles

Off-label use in high-risk, recurrent or metastatic Endometrial carcinoma:

  • 50 mg/m2 intravenous on day 1 every 3 weeks in combination with doxorubicin ± paclitaxel for 7 cycles or until disease progression or unacceptable toxicity

Off-label uses in Esophageal and gastric cancers:

  • CF regimen:
    • 100 mg/m2 intravenous over 30 minutes on days 1 and 29 in combination with fluorouracil (preoperative chemoradiation)
  • ECF, ECX regimens (advanced disease):
    • 60 mg/m2 intravenous on day 1 every 21 days for up to 8 cycles in combination with epirubicin (E) and either fluorouracil (F) or capecitabine (X) or
  • ECF regimen:
    • 60 mg/m2 intravenous on day 1 every 21 days for 3 preoperative and 3 postoperative cycles in combination with epirubicin and fluorouracil
  • TCF or DCF regimen:
    • 75 mg/m2 intravenous on day 1 every 3 weeks in combination with docetaxel and fluorouracil until disease progression or unacceptable toxicity.

Off-label use in high-risk metastatic Gestational trophoblastic neoplasia:

  • EMA-EP regimen:
    • 60 to 80 mg/m2 on day 8 every 2 weeks in combination with etoposide, methotrexate, leucovorin, and dactinomycin
    • continue for 2 to 4 treatment cycles after a normal hCG level
  • EP-EMA regimen:
    • 25 mg/m2 /dose over 4 hours each for 3 consecutive doses on day 1 in combination with etoposide, alternating weekly with EMA (etoposide, methotrexate, leucovorin, and dactinomycin)

Off-label use in Head and neck cancer:

  • Locally-advanced disease:
    • 100 mg/m2 intravenous on day 1 every 3 weeks for 3 doses with concurrent radiation or
    • 75 mg/m2 on day 1 every 3 weeks in combination with docetaxel and fluorouracil for 4 cycles or until disease progression or unacceptable toxicity or
    • 100 mg/m2 intravenous on day 1 every 3 weeks in combination with docetaxel and fluorouracil for 3 cycles or until disease progression or unacceptable toxicity
  • Metastatic disease:
    • 100 mg/m2 intravenous on day 1 every 3 weeks in combination with fluorouracil and cetuximab until disease progression or unacceptable toxicity or a maximum of 6 cycles.

Off-label use in advanced Hepatobiliary cancer:

  • 25 mg/m2 over 2 hours on days 1 and 8. Repeat the cycle every 3 weeks in combination with gemcitabine for 4 to 8 cycles

Off-label use in relapsed or refractory Hodgkin lymphoma:

  • DHAP regimen:
  • ESHAP regimen:
    • 25 mg/m2 /day on days 1 to 4 in combination with etoposide, methylprednisolone, and cytarabine every 3 to 4 weeks for 3 or 6 cycles.

Off-label use in Malignant pleural mesothelioma:

  • 75 mg/m2 intravenous on day 1 every 3 weeks in combination with pemetrexed or
  • 100 mg/m2 on day 1 every 4 weeks in combination with gemcitabine or
  • 80 mg/m2 on day 1 every 3 weeks in combination with gemcitabine

Off-label use in Multiple myeloma:

  • VDT-PACE regimen:
    • 10 mg/m2 /day administered as a continuous infusion on days 1 to 4 of each cycle. Repeat every 4 to 6 weeks in combination with bortezomib, dexamethasone, thalidomide, doxorubicin, cyclophosphamide, and etoposide.

Off-label use in relapsed or refractory Non-Hodgkin lymphoma:

  • DHAP regimen (for DLBCL):
    • 100 mg/m2 continuous infusion over 24 hours on day 1 every 3 to 4 weeks for 6 to 10 cycles in combination with dexamethasone and cytarabine.
  • ESHAP regimen:
    • 25 mg/m2 /day continuous infusion over 24 hours on days 1 to 4 every 3 to 4 weeks for 6 to 8 cycles in combination with etoposide, methylprednisolone, and cytarabine.

Off-label use in Non-small cell lung cancer:

Note: For the treatment of Non-small cell lung cancer multiple cisplatin-containing regimens are being used:

  • 100 mg/m2 on day 1 every 4 weeks in combination with etoposide for 3 to 4 cycles
  • 100 mg/m2 on day 1 every 4 weeks in combination with vinorelbine
  • 100 mg/m2 on day 1 every 4 weeks in combination with gemcitabine
  • 80 mg/m2 on day 1 every 3 weeks in combination with gemcitabine
  • 75 mg/m2 on day 1 every 3 weeks in combination with pemetrexed for up to 6 cycles until disease progression or unacceptable toxicity

Off-label use in Osteosarcoma:

  • Adults 40 years of age or older:
    • 60 mg/m2 /day intravenous over 4 hours for 2 days (total of 120 mg/m2 /cycle) of weeks 1 and 6 (neoadjuvant therapy) and then 60 mg/m2/day over 4 hours for 2 days (total of 120 mg/m /cycle) of weeks 12 and 17 (adjuvant therapy) in combination with methotrexate, leucovorin, and doxorubicin.

Advanced Ovarian cancer:

  • 75 to 100 mg/m2 intravenous once every 3 to 4 weeks or
  • 75 mg/m2 every 3 weeks in combination with paclitaxel
  • 100 mg/m2 on day 2 of a 21-day treatment cycle in combination with intravenous and intraperitoneal paclitaxel for 6 cycles

Off-label use in metastatic Penile cancer:

  • 25 mg/m2 intravenous over 2 hours on days 1, 2, and 3 every 3 to 4 weeks in combination with paclitaxel and ifosfamide for 4 cycles

Off-label use in Small cell lung cancer:

  • Limited-stage disease:
    • 60 mg/m2 intravenous on day 1 every 3 weeks for 4 cycles in combination with etoposide and concurrent radiation
  • Extensive-stage disease:
    • 80 mg/m2 intravenous on day 1 every 3 weeks in combination with etoposide for 4 cycles or a maximum of 8 cycles.
    • 60 mg/m2 on day 1 every 4 weeks for 4 cycles in combination with irinotecan

Advanced Testicular cancer:

  • 20 mg/m2 intravenous once daily for 5 days repeated every 3 weeks in combination with bleomycin and etoposide

Testicular germ cell tumor, malignant:

  • 25 mg/m2 intravenous on days 2 to 5 every 3 weeks in combination with paclitaxel and ifosfamide for 4 cycles
  •  20 mg/m2 intravenous on days 1 to 5 every 3 weeks in combination with bleomycin and etoposide for 4 cycles
  •  20 mg/m2 on days 1 to 5 every 3 weeks in combination with etoposide and ifosfamide for 4 cycles

Off-label use in advanced or metastatic Thymomas:

  • CAP regimen:
    • 50 mg/m2 intravenous over at least 1 hour on day 1 every 3 weeks for up to 8 cycles in combination with cyclophosphamide and doxorubicin
  • ADOC regimen:
    • 50 mg/m2 on day 1 every 3 weeks in combination with doxorubicin, vincristine, and cyclophosphamide
  • PE regimen:
    • 60 mg/m2 over 1 hour on day 1 every 3 weeks in combination with etoposide.

Cisplatin Dose in Children:

Note: Pretreatment hydration prior to every course of cisplatin along with antiemetics is recommended.

Germ cell tumors:

  • Infants:
    • 0.7 mg/kg intravenous on days 1 to 5 of a 21-day cycle in combination with bleomycin and etoposide
  • Children and Adolescents:
    • 20 mg/m2 on days 1 to 5 of a 21-day cycle in combination with bleomycin and etoposide
    • 100 mg/m2 on day 1 of a 21-day cycle in combination with bleomycin and vinblastine or etoposide.
  • Children and Adolescents:
    • PE regimen:
      • 35 mg/m2 intravenous on days 1, 2, and 3 of a 21-day cycle for 3 cycles (weeks 1, 4, and 7) in combination with etoposide. Depending on the response to therapy a fourth cycle may be considered.
    • PEI regimen:
      • 35 mg/m2 intravenous on days 1, 2, and 3 of a 21-day cycle for 4 cycles (weeks 1, 4, 7, and 11) in combination with etoposide and ifosfamide. Depending on the response to therapy a fifth cycle may be considered.

Hepatoblastoma: 

  • Infants and Children less than 10 kg:
    • PLADO regimen:
      • 2.7 mg/kg/day continuous intravenous infusion over 24 hours on day 1 of a 21-day cycle in combination with doxorubicin for 4 to 6 cycles
  • Children 10 kgs or more and Adolescents:
    • Monotherapy:
      • 80 mg/m2 /day continuous infusion over 24 hours every 2 weeks on day 1
    • Combination therapy:
      • 80 mg/m2 /day continuous infusion over 24 hours on day 1 of a 21-day cycle in combination with doxorubicin or doxorubicin and sorafenib.

Intermittent infusion (over 6 hours):

  • Infants and Children less than 10 kg:
    • 3 mg/kg over 6 hours on day 1 of a 21-day cycle for 4 to 8 cycles in combination with vincristine and fluorouracil or continuous infusion doxorubicin.
  • Children older than 10 kg and Adolescents:
    • 90 mg/m2 over 6 hours on day 1 of a 21-day cycle for 4 to 8 cycles in combination with vincristine and fluorouracil or continuous infusion doxorubicin.

Medulloblastoma:

  • Children older than 3 years and Adolescents:
    • 75 mg/m2 intravenous every 6 weeks on either day 0 in combination with vincristine and cyclophosphamide day 1 in combination with lomustine and vincristine of each chemotherapy cycle for 8 cycles.

Relapsed or refractory Medulloblastoma/PNET:

  • Children and Adolescents:
    • 60 mg/m2 on day 0 every 4 weeks in combination with irinotecan, vincristine, cyclophosphamide, and etoposide

High risk Neuroblastoma:

  •  Infants, Children, and Adolescents:
    • 50 mg/m2 intravnous on days 0 to 3 of a 21-day cycle in combination with etoposide (cycles 3 and 5)
    • 50 mg/m2 on days 1 to 4 in combination with etoposide (cycles 3, 5, and 7)

Osteosarcoma:

  • Children and Adolescents:
    • 60 mg/m2 /day for 2 days at weeks 2, 7, 25, and 28 (neoadjuvant) or weeks 5, 10, 25, and 28 (adjuvant) in combination with doxorubicin or 120 mg/m2 /day at weeks 0, 5, 12, and 17 in combination with doxorubicin.

Pregnancy Risk Factor D

  • Cisplatin crosses into the human placenta, and can cause fetal harm to a pregnant woman.
  • Effective contraception should be used by females with reproductive potential during and after cisplatin treatment.
  • Before initiating therapy, it is important to rule out pregnancy in women of reproductive age.
  • Effective contraception should be used by male patients who have female partners with reproductive potential during treatment, and for the next eleven months.
  • Cisplatin can cause premature menopause, ovarian failure and impairment of spermatogenesis. It may also reduce female and male fertility.

Breastfeeding: Cisplatin is used

  • Because of possible adverse effects on infants, the manufacturer suggests that you avoid breastfeeding.

Cisplatin dose in renal disease:

  • Please Note: The following is a summary of theManufacturer: Patients with renal impairment or patients who have experienced significant renal impairment due to cisplatin treatment should seek out an alternative chemotherapeutic drug. These are the recommended dose adjustments for patients with renal impairment:
  • CrCl 10 to 50 mL/minute:
    • Administer 75% of the dose
  • CrCl of less than 10 mL/minute:
    • Administer 50% of the dose
  • Hemodialysis:
    • Partially cleared by hemodialysis (Administer 50% of dose post-hemodialysis)
  • Continuous ambulatory peritoneal dialysis (CAPD):
    • Administer 50% of the dose
  • Continuous renal replacement therapy (CRRT):
    • Administer 75% of the dose

Dose in Kidney disease:

The manufacturer has not recommended any dose adjustment in patients with liver disease.

Common Side Effects of Cisplatin:

  • Central nervous system:
    • Neurotoxicity
  • Gastrointestinal:
    • Nausea and vomiting
  • Genitourinary:
    • Nephrotoxicity
  • Hematologic & oncologic:
    • Anemia
    • Leukopenia
    • Thrombocytopenia
  • Hepatic:
    • Increased liver enzymes
  • Otic:
    • Ototoxicity

Less Common Side Effects:

  • Local:
    • Local irritation

Contraindications to cisplatin:

  • Severe allergic reactions

Warnings and Precautions

  • Suppression of bone marrow[US Boxed Warning]
    • CisplatinThis can lead to severe and fatal infections. It is important to monitor patients for symptoms and signs of infection.
    • PeriodicBlood countsYou should always be on guard.
  • Extravasation
    • Higher concentrations of Cisplatin can cause irritation and be vesicant. Before initiating therapy, the catheter and intravenous line should be correctly placed. Drug extravasation should be closely monitored. Cisplatin infusion solutions containing more than 0.5 mg/mL can cause tissue cellulitis, fibrosis and necrosis as well as pain, edema and erythema.
  • Gastrointestinal toxicities: [US Boxed Warning]
    • Cisplatin can cause nausea and vomiting. It is important to use an antiemetic medication for treatment.
  • Hypersensitivity
    • Cisplatin infusions have been linked to severe allergic reactions, including anaphylactic shock.
    • Allergy symptoms may include facial edema and wheezing as well as hypotension.
    • It is important to stop the infusion immediately and avoid any re-infusions.
  • Nephrotoxicity[US Boxed Warning]
    • Cisplatin can cause severe kidney toxicity, leading to acute renal failure.
    • Monitor renal function and electrolytes, including magnesium and calcium levels, at baseline and during therapy.
    • If renal function starts to deteriorate, the therapy should be stopped or adjusted.
    • If patients develop hypomagnesemia after receiving cisplatin therapy, they may need to supplement their magnesium.
  • Neurotoxicity:[US Boxed Warning]
    • CisplatinDose-related peripheral neuropathy may develop after repeated cisplatin treatments. It can occur up to 3-8 weeks after the last dose.
    • Paresthesias, stocking-glove distribution, areflexia and loss of vibratory sensation and proprioception are all signs of neurotoxicity.
    • Sometimes, neuropathy can develop even after discontinuation of cisplatin.
    • Before cisplatin is initiated, during therapy, and after it has been completed, a complete neurological exam should be done.
    • If you develop symptoms of peripheral neuropathy, Cisplatin can be stopped.
    • Other neurological features include seizures and loss of motor function, loss in taste, leukoencephalopathy (PRES [formerly RPLS]), and posterior reversible Leukoencephalopathy Syndrome (PRES).
  • Ocular toxicities:
    • Optic neuritis and papilledema have been reported in patients who received standard recommended doses of cisplatin.
    • After discontinuing cisplatin, improvement and recovery are common.
  • Ototoxicity:
    • Cisplatin has been linked to severe ototoxicity, including deafness, which manifests as tinnitus, hearing loss at high frequencies (4,000 to 8,800 Hz), and/or reduced ability to hear normal conversational sounds.
    • For all children receiving cisplatin, audiometric and vestibular testing should be considered.
    • Audiometric testing should be done at the beginning of therapy, before each dose and for many years after it is stopped.
  • Secondary malignancies
    • Secondary malignancies can develop in patients who take cisplatin with other chemotherapeutic drugs.
  • Tumor lysis syndrome
    • Cell lysis can lead to hyperuricemia in patients. Patients who are on cisplatin therapy should be treated for hyperuricemia

Cisplatin: Drug Interaction

Note: Drug Interaction Categories:

  • Risk Factor C: Monitor When Using Combination
  • Risk Factor D: Consider Treatment Modification
  • Risk Factor X: Avoid Concomitant Use

Risk Factor C (Monitor therapy).
Alpha-Lipoic acid May decrease the therapeutic effects of CISplatin.
Aminoglycosides CISplatin could increase the nephrotoxic effects of Aminoglycosides.
Chloramphenicol Ophthalmic May increase the toxic/adverse effects of Myelosuppressive Agents.
CloZAPine CloZAPine's toxic/adverse effects may be exacerbated by myelosuppressive agents. Particularly, there may be an increase in the risk of neutropenia.
Coccidioides immitis skin test Coccidioides immitis Skin Test may be affected by immunosuppressants.
Denosumab Might increase the toxic/adverse effects of Immunosuppressants. In particular, there may be an increase in the risk of serious infections.
Fosphenytoin - Phenytoin The serum concentration of Fosphenytoin -Phenytoin may be decreased by Platinum Derivatives
Loop Diuretics May increase the nephrotoxic effects of CISplatin. Loop diuretics can increase the ototoxic effects of CISplatin.
Ocrelizumab May increase the immunosuppressive effects of Immunosuppressants.
Pidotimod Pidotimod's therapeutic effects may be diminished by immunosuppressants.
Promazine May increase the myelosuppressive effects of Myelosuppressive Drugs.
Siponimod Siponimod's immunosuppressive effects may be enhanced by taking immunosuppressants.
Sipuleucel - T Sipuleucel T's therapeutic effects may be diminished by immunosuppressants
Tertomotide Tertomotide's therapeutic effects may be diminished by immunosuppressants.
Trastuzumab May increase the neutropenic effects of Immunosuppressants.
Vinorelbine Vinorelbine's toxic/adverse effects may be exacerbated by CISplatin. The combination could increase the risk of developing granulocytopenia.

Risk Factor D (Consider therapy modifications)
Baricitinib Baricitinib's immunosuppressive effects may be enhanced by immunosuppressants. Baricitinib should not be used in combination with immunosuppressants like azathioprine and cyclosporine. It is permissible to use methotrexate antirheumatically or nonbiologic disease-modifying antirheumatic drug (DMARDs), concurrently.
Echinacea Might decrease the therapeutic effects of Immunosuppressants.
Fingolimod Fingolimod may be immunosuppressed by immunosuppressants. When possible, avoid the use of fingolimod with other immunosuppressants. Patients should be closely monitored for any additive immunosuppressant effects, such as infections, if they are used together.
Leflunomide Leflunomide's toxic/adverse effects may be exacerbated by immunosuppressants. The risk of hematologic toxicities such as pancytopenia and agranulocytosis may increase. Patients on immunosuppressants should not be given a leflunomide loading dosage. Patients who are receiving leflunomide or another immunosuppressant must be checked for bone marrow suppression at minimum monthly.
Lenograstim Antineoplastic Agents can reduce the therapeutic effects of Lenograstim. Management: Lenograstim should be avoided 24 hours prior to and 24 hours following the completion of myelosuppressive, cytotoxic chemotherapy.
Lipegfilgrastim Antineoplastic agents may reduce the therapeutic effects of Lipegfilgrastim. Management: It is important to avoid the simultaneous use of lipegfilgrastim with myelosuppressive, cytotoxic chemotherapy. After myelosuppressive chemotherapy has been completed, lipegfilgrastim must be given at least 24 hours.
Nivolumab Nivolumab's therapeutic effects may be diminished by immunosuppressants.
Palifermin Can increase the toxic/adverse effects of Antineoplastic Agents. In particular, oral mucositis can be more severe and prolonged. Management: Avoid palifermin administration within the first 24 hours of infusion or 24 hours following myelotoxic chemotherapy.
Roflumilast May increase the immunosuppressive effects of Immunosuppressants.
Taxane Derivatives The myelosuppressive effects of Taxane derivatives may be enhanced by platinum derivatives. To limit toxicities, administer Taxane derivative prior to Platinum derivative if given in sequential infusions.
Tofacitinib Tofacitinib's immunosuppressive effects may be enhanced by immunosuppressants. Management: It is permissible to use methotrexate (or nonbiologic disease-modifying antirheumatic drug (DMARDs), concurrently with antirheumatic doses. This warning appears to be particularly targeted at more potent immunosuppressants.
Topotecan Topotecan's toxic/adverse effects may be exacerbated by Platinum Derivatives.
Vaccines (Inactivated). Immunosuppressants can reduce the therapeutic effects of Vaccines (Inactivated). Management: The effectiveness of vaccines may be decreased. All age-appropriate vaccines must be completed at least two weeks before you start an immunosuppressant. Re-vaccinate anyone who was vaccinated while on immunosuppressant therapy.

Risk Factor X (Avoid Combination)
BCG (Intravesical). The therapeutic effects of BCG (Intravesical) may be diminished by immunosuppressants
BCG (Intravesical). Myelosuppressive agents may reduce the therapeutic effects of BCG (Intravesical).
Cladribine May increase the immunosuppressive effects of Immunosuppressants.
Cladribine May increase the myelosuppressive effects of Myelosuppressive Drugs.
Deferiprone Deferiprone may have a neutropenic effect that myelosuppressive agents can increase.
Dipyrone May increase the toxic/adverse effects of Myelosuppressive Agents. In particular, there may be an increase in the risk of pancytopenia and agranulocytosis.
Natalizumab Natalizumab's toxic/adverse effects may be exacerbated by immunosuppressants. Particularly, concurrent infections may increase.
Pimecrolimus May increase the toxic/adverse effects of Immunosuppressants
Tacrolimus - Topical May increase the toxic/adverse effects of Immunosuppressants
Vaccines (Live). Immunosuppressants can increase the toxic/adverse effects of Vaccines (Live). Immunosuppressants can decrease the therapeutic effects of Vaccines. Management: Live-attenuated vaccines should be avoided for at least three months following immunosuppressants.

Monitoring Parameters:

  • Monitor blood counts prior to cisplatin initiation & each subsequent treatment course, and as clinically indicated.
  • Monitor serum creatinine, blood urea nitrogen, creatinine clearance, and serum electrolytes including serum calcium, magnesium, potassium, and sodium prior to treatment initiation and as clinically indicated.
  • Consider audiometric and vestibular testing, particularly in pediatric patients receiving cisplatin (pediatric patients should receive audiometric testing at baseline, prior to each dose, and for several years after discontinuing therapy).
  • Monitor for hypersensitivity reactions. Monitor for signs/symptoms of infection (during and after cisplatin treatment), neuropathy, ocular toxicity, and secondary malignancies.
  • Monitor the infusion site during administration.

How to administer cisplatin?

To ensure adequate urine output, patients should be well-hydrated before administration. To prevent nausea or vomiting, antiemetic medication should be used.

  • Cisplatin can be administered intravenously at a rate up to 1 mg/minute, or as a continuous infusion. You should not give it as an intravenous injection.
  • Intraperitoneal administration: The solution is prepared using warm saline. It is then infused through an intraperitoneal catheter.
  • Aluminum-containing IV administration sets or Needles should not be used.
  • This is because aluminum can react with cisplatin, causing precipitate formation and loss in potency.
  • It is a vesicant at higher concentrations. To avoid extravasation, ensure proper catheter or needle placement before and during infusion.

Extravasation management

  • Extravasation should be immediately stopped and the solution gently aspirated (IV Line).
  • NOT to be fLushed As an antidote, Sodium thiosulfate must be applied to the affected limb.
  • To inject 100mg of cisplatin into extravasation, add 2 ml sodium thiosulfate 1/6M solution to the IV line.
  • Next, give 1 ml subcutaneous injections of 1 ml around the extravasation. 
  • You can repeat the subcutaneous injections for up to four hours.
  • Apply Dimethyl sulfoxide to the affected region twice every 8 hours for seven days. 
  • Do not cover the area with a dressing if extravasation occurs within 10 minutes.

Mechanism of action of cisplatin:

Cisplatin blocks DNA synthesis by:

  • The formation of DNA cross-links
  • Denatures the double-helical structure
  • Covalent binding to DNA bases disrupts DNA function
  • They may also bind with proteins
  • The cytotoxic effect of the cis-isomer on cells is 14 times greater than that of the trans-isomer.

Protein bound is more than 90%. It is not enzyme inactivated in cells or bloodstream.

The elimination of half-life in children at 1.3Hours (free drug) or 44 hours (total platin). 

Half-life of cisplatin in adults is less than an hour, while that of platinum takes more than five days. 

It is excreted mostly through urine.

Cisplatin International Brands:

  • Abiplatin
  • Accocit
  • Bioplatino
  • Blastolem
  • Blastolem RU
  • Cesalin
  • Ciscan
  • Cisly
  • Cispatin
  • Cisplan
  • Cisplat
  • Cisplatin
  • Cisplatin Ebewe
  • Cisplatin medac
  • Cisplatin Teva
  • Cisplatin-Ebewe
  • Cisplatine-Lilly
  • Cisplatino
  • Cisplatinum Cytosafe-Delta
  • West
  • Cisplatyl
  • Cisteen
  • Citoplatino
  • Citoplax
  • Cysplack
  • Elvecis
  • Fangtan
  • Incel
  • Kemocarb
  • Kemoplat
  • Lederplatin
  • Noveldexis
  • Oncotin
  • P&U Cisplatin
  • Placis
  • Platamine
  • Platicin
  • Platidiam
  • Platimit
  • Platin
  • Platinol
  • Platistil
  • Platistin
  • Platol
  • Platosin
  • Randa
  • Sicatem
  • Sinplatin
  • Tecnoplatin
  • Unistin

Cisplatin Brands in Pakistan:

Cisplatin Injection 1 mg/ml
PLATINIL NEO MEDIX

 

Cisplatin Injection 10 mg/ml
BLASTOLEM SCHARPER PHARMACEUTICALS (PVT) LTD.
CEPLATIN PHARMEDIC (PVT) LTD.
CISPLATIN BIO PHARMA
CISPLATINUM S. EJAZUDDIN & COMPANY
CYTOPLATIN A. J. MIRZA PHARMA (PVT) LTD
KEMOPLAT ATCO LABORATORIES LIMITED
PLATIMIT PLIVA PAKISTAN (PVT) LIMITED
PLATOSIN TURNER GRAHAMS OF PAKISTAN (PVT) LTD.
UNISTIN AL-HABIB PHARMACEUTICALS.

 

Cisplatin Injection 25 mg/ml 
CEPLATIN PHARMEDIC (PVT) LTD.
CISPLATINUM S. EJAZUDDIN & COMPANY
PLATIDIAM UMAIR ASSOCIATES

 

Cisplatin Inj 50 mg/ml
BLASTOLEM SCHARPER PHARMACEUTICALS (PVT) LTD.
CEPLATIN PHARMEDIC (PVT) LTD.
CISPLASOL PFIZER LABORATORIES LTD.
CISPLATIN ATCO LABORATORIES LIMITED
CISPLATIN HIGHNOON LABORATORIES LTD.
CISPLATIN BIO PHARMA
CISPLATINUM S. EJAZUDDIN & COMPANY
CYTOPLATIN A. J. MIRZA PHARMA (PVT) LTD
KEMOPLAT ATCO LABORATORIES LIMITED
ONCOPLATIN CONSOLIDATED CHEMICAL LABORATORIES (PVT) LTD.
PLATOSIN TURNER GRAHAMS OF PAKISTAN (PVT) LTD.
UNISTIN AL-HABIB PHARMACEUTICALS.

 

Cisplatin Inj 100 mg/ml
CISPLATIN ATCO LABORATORIES LIMITED

 

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